Hull Public Health 

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Mental Health

What's New

The Hull JSNA Toolkit Realease 5 topic-specific report on Mental Health and Learning Disabilities, which includes information on autism, is available to download here.


Documents

The main documents providing information on mental health are as follows:

JSNA
Hull JSNA Toolkit: Mental Health and Learning Disabilities
Mental Health Equity Audit completed March 2007

Other documents which include information on mental health or associated information are as follows:

JSNA Hull Atlas
Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here)
Public Health Outcomes Framework Summary
Longer Lives Briefing Report
Director of Public Health Annual Reports, including:

DPH Annual Report 2005 – "A Window on Homelessness"
DPH Annual Report 2011 - "Outlook: An Enlightened View of Hull"

Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report

Hull JSNA Toolkit: Mental Health and Learning Disabilities includes a section on all types of mental health and separate sections on serious mental health, dementia, and suicide and undetermined injury. Information is presented on risk factors, prevalence, inpatient admissions and mortality where information is available and numbers are sufficiently large. Modelled prevalence is compared with diagnosed prevalence at practice level, and admission rates and mortality rates are compared among deprivation quintiles.

The Mental Health Equity Audit was completed March 2007. This document includes information on risk factors, inpatient admissions and mortality for mental health. This information is examined in relation to age, gender and deprivation to assess potential inequalities that might exist among these groups. The document also examined potential programmes that could reduce health inequalities.

Social capital examines social networks, trust, safety and social support so information is included within the mental health section of Hull JSNA Toolkit: Mental Health and Learning Disabilities with more detail within the survey reports:

Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report

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Background

It is relatively difficult to assess the impact of poor mental health. Information relating to the prevalence of mental health is limited with generally only information on the prevalence of serious mental health conditions such as schizophrenia etc. The numbers of people requiring hospital admission or who die from mental health conditions is small and therefore it is not straightforward to present the information. Around half of hospital admissions for mental and behavioural disorders are for substance misuse. As well as there being limited information on the prevalence and impact of less serious mental health conditions, the assessment of mental health is made more difficult as people may choose not to seek help and it is possible that a large proportion of mental ill-health is undiagnosed.

The mental health section within Hull JSNA Toolkit: Mental Health and Learning Disabilities and the Mental Health Equity Audit include information on the conditions within the 'mental and behavioural disorders' chapter defined using the International Classification of Diseases (ICD) version 10, but also include information on suicide and undetermined injury which is within another chapter of the ICD.

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Alcohol Abuse

The prevalence of alcohol consumption among adults and young people is summarised within Hull JSNA Toolkit: Alcohol Consumption and detailed within the Adults and Young People Health and Lifestyle Survey reports. Hospital admissions and mortality rates for substance abuse, which includes alcohol, are presented within Hull JSNA Toolkit: Drug and Substanc Abuse, as well as being presented for different deprivation groups. The predicted numbers requiring social care for substance abuse for 2015, 2020, 2025 and 2030 among Hull residents aged 18-64 years are also given in Hull JSNA Toolkit: Drug and Substance Abuse.

Also see Alcohol.

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Asset Approach

The asset approach could have a significant impact on improving mental health within communities, since people's mental wellbeing is significantly socially determined and anything that boosts social networks and sustains community resilience can enable people to cope with adversity and reach their full potential.

Asset mapping could be used to develop 'social prescribing' – in which health workers prescribe social and community solutions such as befriending schemes, volunteering, access to educational or IT skills, support to make use of the library or local sports facilities etc. The aim would be to improve people's resilience through increasing social connections and sustaining networks that promote self-care and improve health-related behaviours. It would be a reciprocal scheme, where people accessing the scheme also contribute their own assets and it is all about identifying, developing and connecting the assets that exist within communities.

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Asylum Seekers

Poor mental health was found among asylum seekers and is detailed within the BME Health and Lifestyle Survey 2007 Main Report.

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Benefit Claimants

Information on claimant rates for incapacity benefit and severe disablement allowance claimants where the main reason for the claim is mental health reasons is presented within Hull JSNA Toolkit: Deprivation and Associated Measures.

For associated information, see Deprivation.

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Bullying

Bullying was included as a topic in the school-based surveys conducted among young people (aged 11-16 years) living in Hull. Information is available in the reports:

Young People Health and Lifestyle Survey 2012 Main Report
Young People Health and Lifestyle Survey 2008-09 Main Report
Young People Health and Lifestyle Survey 2002 Main Report

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Dementia

The prevalence and modelled prevalence for each general practice, inpatient admissions and mortality rates are given in Hull JSNA Toolkit: Mental Health and Learning Disabilities. The prevalence, inpatient admission rate and mortality rate are also given in relation to deprivation.

Dementia is a key strategic aim within the Health and Wellbeing Board Action Plan. "People with dementia have the help they need to live safely in their homes. All of the care and help that they and their families get will be of good quality."

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030. It provides estimates of the number of people aged 65+ years in Hull are predicted to have dementia. These estimates are available in Hull JSNA Toolkit: Mental Health and Learning Disabilities and Hull JSNA Toolkit: Older People.

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Employment

The gap in the overall employment rate and the employment rate for those with a learning disability and with serious mental illness are both indicators within the Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

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Expenditure and Programme Budgeting

Expenditure and Programme Budgeting is given in the disease-specific Hull JSNA Toolkit reports for the main diseases which includes mental health.

Programme Budgeting is a well-established technique for assessing investment in health programmes rather than services. It can provide an overall view of how Hull PCT expenditure (from Department of Health Programme Budgeting information) and health outcomes compare with other PCT's in England, and to identify programmes that may require further investigation. Quadrant charts are given in the topic-specific Hull JSNA Toolkit reports which plot expenditure and outcomes (in standardised units) for different disease areas.

There are also specific programme budgeting and marginal analysis reports for mental health which examines expenditure in relation to outcomes for Hull and compares these with other comparator areas:

PBMA Mental Health 2009/10
PBMA Mental Health 2008/09
PBMA Mental Health 2007/08

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GP Consultations

The prevalence of mental health is difficult to determine as people do not necessarily seek help and it is possible that a large proportion of mental ill-health is undiagnosed. Furthermore, people consulting their GP for mental ill-health may also consult at the same time for physical health problems. Information on GP consultations is not readily available, but the fourth national study carried out by the Royal College of General Practitioners, the Office of Population Censuses and Surveys, and the Department of Health examined morbidity statistics in General Practice during 1991-92. This survey provides the most up-to-date reasons why people consult their GP. The pattern of consultations may have changed since 1991-92, but the information gives an indication of consultations. Information is given within Hull JSNA Toolkit: Mental Health and Learning Disabilities, which also estimates total number of people with different mental ill-health using the GP consultation prevalence estimates.

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Health Equity Audit

The Mental Health Equity Audit was completed March 2007. This document includes information on risk factors, inpatient admissions and mortality for mental health. This information is examined in relation to age, gender and deprivation to assess potential inequalities that might exist among these groups. The document also examined potential programmes that could reduce health inequalities.

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Inpatient Admissions

The number of inpatient admissions and admission rate for each main type of mental illness are given in Hull JSNA Toolkit: Mental Health and Learning Disabilities as well as admission rates by ward for substance abuse, all other mental health excluding substance abuse, self-harm and dementia. Admission rates are also examined in relation to deprivation.

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Learning Disabilities

The prevalence and modelled prevalence for each general practice are given in Hull JSNA Toolkit: Mental Health and Learning Disabilities and Hull JSNA Toolkit: General Health, Disabilities, Caring and Use of Healthcare Services. The prevalence is also given in relation to deprivation, as well as information on expenditure. Hull JSNA Toolkit: Mental Health and Learning Disabilities and Hull JSNA Toolkit: General Health, Disabilities, Caring and Use of Healthcare Services also give the predicted numbers requiring social care for learning disabilities for 2015, 2020, 2025 and 2030 among Hull residents aged 18-64 years.

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030. It provides estimates of the number of people aged 65+ years in Hull are predicted to have learning disabilities. These estimates are available in Hull JSNA Toolkit: Mental Health and Learning Disabilities, Hull JSNA Toolkit: General Health, Disabilities, Caring and Use of Healthcare Services and Hull JSNA Toolkit: Older People.

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Living Independently

The percentage of working-age learning disabled clients (18-64 years) who are living in their own home and the percentage of adults aged 18-69 years receiving secondary mental health services who live independently are both indicators within the Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

For associated information, see Environmental Factors and Housing

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Looked After Children

The emotional health of looked after children is an indicator within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. This is also given at ward level in the JSNA Hull Atlas.

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Mortality

Mortality rates and mortality rates by deprivation are given in Hull JSNA Toolkit: Mental Health and Learning Disabilities. Numbers are small, but limited information is presented for dementia, substance abuse, self-harm and suicide and undetermined injury.

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Prevalence

As part of the Quality and Outcomes Framework (QOF), practices need to have registers of patients who have had a diagnosis of that specific disease. More information about QOF is given in the topic-specific Hull JSNA Toolkit reports and Glossary. The QOF general practice disease registers cover a range of medical conditions and diseases including dementia and serious mental illness, and the prevalence is reported within Hull JSNA Toolkit: Mental Health and Learning Disabilities. These are also presented by deprivation.

Some of the issues associated with comparing prevalence figures over all the Hull practices are discussed within the General Practice Comparator Groupings, Hull JSNA Toolkit: Mental Health and Learning Disabilities and Glossary, with more detailed information within the Why QOF Differs Among Practices report. Details of grouping practices into eight groups for benchmarking are given in the General Practice Comparator Groupings.

This actual diagnosed prevalence is compared with modelled prevalence estimates. These modelled estimates and the difference between the modelled estimates and the numbers diagnosed at practice level are given within Hull JSNA Toolkit: Mental Health and Learning Disabilities. A modelled or synthetic estimate is only as good as the model and as good as the underlying data from which the model is produced. A full discussion of the Problem of Synthetic Estimates is available, and it is also discussed within Hull JSNA Toolkit: Mental Health and Learning Disabilitiesand Glossary.

The prevalence of mental health is difficult to determine as people do not necessarily seek help and it is possible that a large proportion of mental ill-health is undiagnosed. The local Surveys have collected self-reported information on mental health using a number of sets of questions, such as the Health Utilities Index, and the Mental Health Index (part of the SF-36v2™ – see Glossary for more information about the SF-36 and the Health Utilities Index) and additional questions on levels of 'stress or pressure'. Young people were asked if they were worried about a number of factors within the last month, such as homework, money, health, friends, being bullied, etc, and in the more recent surveys they were asked how frequently they were happy or sad. Information is included in the following survey reports:

Adult Health and Lifestyle Survey 2014 Main Report
Adult Health and Lifestyle Survey 2011-12 Main Report
BME Health and Lifestyle Survey 2011-12 Main Report
Adult Health and Lifestyle Survey 2009 Main Report
Adult Health and Lifestyle Survey 2007 Main Report
BME Health and Lifestyle Survey 2007 Main Report
Gypsy and Traveller Health and Lifestyle Survey 2007 Main Report
Adult Health and Lifestyle Survey 2003 Main Report
Adult Health and Lifestyle Survey 2003 Eastern Hull Tables
Adult Health and Lifestyle Survey 2003 West Hull Tables
Veteran Health and Lifestyle Survey 2009 Main Report
Young People Health and Lifestyle Survey 2012 Main Report
Young People Health and Lifestyle Survey 2008-09 Main Report
Young People Health and Lifestyle Survey 2002 Main Report
Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report

Using estimates of the prevalence of mental health among adults, among children and young people, and among prisoners the total number of people in Hull with different mental health conditions has been estimated within the JSNA Toolkit and Mental Health Equity Audit.

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030. It provides estimates of the number of people aged 65+ years in Hull are predicted to have learning disabilities, depression and dementia. These estimates are available in Hull JSNA Toolkit: Mental Health and Learning Disabilities and Hull JSNA Toolkit: Older People.

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Prisoners

Using estimates of the prevalence of mental health among prisoners the total number of people in Hull with different mental health conditions has been estimated within Hull JSNA Toolkit: Mental Health and Learning Disabilities and the Mental Health Equity Audit.

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Projecting Older People Population Information (POPPI)

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030 (i.e. predictive modelling). It provides various estimates of the number of people aged 65+ years in Hull are predicted to have specific health needs including those related to mental health, social care, providing unpaid care and social isolation such as the numbers predicted to live alone (with and without transport), to have learning disabilities, to have depression, to have dementia, etc. These estimates can be found in Hull JSNA Toolkit: Mental Health and Learning Disabilities and Hull JSNA Toolkit: Older People.

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Public Health Outcomes Framework

There are a number of indicators related to mental health or learning disabilities or associated with emotional health or social isolation within the Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. These include percentage of adults living in stable appropriate accommodation for those with a learning disability and those in contact with secondary mental health services, the gap in the employment rate between the overall employment rate and employment rates for those with a learning disability and those with a serious mental illness, percentage of adults social care users who have as much social contact as they would like, emotional well-being of looked after children, successful completion of drug treatment, self-reported well-being (in relation to a satisfaction score, worthwhile score, happiness score and anxiety score), and suicide rate.

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Self-Harm

The emergency hospital admission rate for admissions related to self-harm are given in Hull JSNA Toolkit: Mental Health and Learning Disabilities.

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Social Capital

Two Social Capital Surveys have been conducted in Hull, but the Adult Health and Lifestyle Surveys also included some social capital questions including the surveys undertaken among Black and Minority Ethnic (BME) groups and the Gypsy and Travellers. Social capital examines feelings of safety when walking around after dark in the community, civic engagement, neighbourliness, social networks and social support. It is argued that improved social capital can have a positive influence on the mental health and well-being of the people living in the community. However, it should also be noted that there can sometimes be a negative effect with improved social capital such as social networks which, for example, lead to easier access to smuggled tobacco or drugs, peer-pressure to continue smoking or eating a poor diet. There are different types of social capital. Bonding social capital is narrow and more internal, and relates to immediate families, close friends and neighbours. Bridging social capital is wider and more external, and relates to looser ties, associated with more diverse relationships such as those with colleagues, acquaintances and other communities. Summary information is included within the mental health section of Hull JSNA Toolkit: Mental Health and Learning Disabilities with more detail within the survey reports:

Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report
Adult Health and Lifestyle Survey 2014 Main Report
Adult Health and Lifestyle Survey 2011-12 Main Report
BME Health and Lifestyle Survey 2011-12 Main Report
Adult Health and Lifestyle Survey 2007 Main Report
BME Health and Lifestyle Survey 2007 Main Report
Gypsy and Traveller Health and Lifestyle Survey 2007 Main Report

For more information, see Social Capital Surveys.

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Stress

The Social Capital Surveys 2004 and 2009 asked survey responders the amount of stress or pressure they had experienced over the past 12 months. In the 2009 survey and the in the 2011-12 Health and Lifestyle Survey, adults were asked if they feel that reducing their stress levels would improve their health. Veterans were also asked about their levels of stress in terms of frequency of feeling fretful or angry, and ways they dealt with stress. Further more detailed information is available within the survey reports, with information summarised in Hull JSNA Toolkit: Mental Health and Learning Disabilities.

Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report
Adult Health and Lifestyle Survey 2011-12
BME Health and Lifestyle Survey 2011-12 Main Report
Veteran's Health and Lifestyle Survey 2009 Main Report

Further information is available in the Attitudes to Health Survey 2007 completed among people aged 40-60 years.

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Substance Abuse

The prevalence among adults, prisoners and young people is given within Hull JSNA Toolkit: Drug and Substance Abuse as well as information on overall inpatient admissions and mortality rates, which are both also presented for different deprivation groups. The predicted numbers requiring social care for substance abuse for 2015, 2020, 2025 and 2030 among Hull residents aged 18-64 years are also given in Hull JSNA Toolkit: Drug and Substance Abuse.

The Young People Health and Lifestyle Surveys also collected information on drug use which is detailed in the survey reports:

Young People Health and Lifestyle Survey 2012 Main Report
Young People Health and Lifestyle Survey 2008-09 Main Report

Veterans were not specifically asked if they themselves used drugs, but asked whether they knew of 'anyone who used to be in the Armed Services' that did so, and they were also asked if they thought this was attributed to, or caused by, their time in the Armed Services and if they had received professional help or advice for drug use. Information is given within the survey report:

Veteran Health and Lifestyle Survey 2009 Main Report

Information is also provided within the JSNA and Mental Health Equity Audit.

Qualitative Research was undertaken involving young people in relation to their attitudes to drugs, details of which can be found in the following reports.

Young People Health and Lifestyle Survey 2012 Reflector Report
Young People Health and Lifestyle Survey 2008-09 Reflector Report

Successful completion (do not re-present within 6 months) of opiate and non-opiate drug treatment programmes are indicators within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

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Suicide and Undetermined Injury

Mortality rates from suicide and undetermined injury as well as rates by deprivation are given within Hull JSNA Toolkit: Mental Health and Learning Disabilities. The number of deaths is also given for different causes and cumulative mortality plots by age over all causes are also produced within Hull JSNA Toolkit: Mortality, although for these latter plots some causes are grouped as the numbers are too small to present.

Mortality from suicide and undetermined injury is an indicator within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

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Veterans and Mental Health

The fieldwork for a Veterans' Health and Lifestyle Survey occurred during Autumn 2009 for Veterans who lived in Hull and had served in the British Armed forces since 1970. Potential survey responders were approached using existing networks and contacts. A press release was also issued encouraging Veterans to come forward to participate in the survey. A total of 53 Veterans completed questionnaires between August and October 2009, and around 20 Veterans completed an in-depth interview. Due to the methodology used to approach Veterans, those who participated in the survey will not necessarily be representative of all Veterans living in Hull.

Veterans were asked if they had any of the following health or lifestyle issues:

i) Depression, anxiety, etc
ii) Post traumatic stress disorder
iii) Problems with controlling violence
iv) Difficulty in obtaining or maintaining a job
v) Smoke too much to help with stress etc
vi) Drink too much alcohol to help with stress etc
vii) Use drugs (cannabis, heroin, ecstasy, etc)
viii) Eat unhealthy diet to help with stress etc

They were also asked if anyone who used to be in the Armed Services had any of these health or lifestyle issues, if they attributed these health or lifestyle issues to the Armed Services and if they had ever received professional help or advice for any of these health or lifestyle issues. Veterans were also asked if they had attended a counselling or psychological appointment within the last year. Details are given in the Veteran Health and Lifestyle Survey 2009 Main Report.

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Worried or Upset

Young people were asked if they were worried about a number of factors within the last month, such as homework, money, health, friends, being bullied, etc. In the first two surveys conducted during 2002 and 2008-09, young people were also asked what things they did if they were worried or upset, such as talking to friends, talking to family, listening to music, smoking tobacco, etc. The findings are given in the survey reports:

Young People Health and Lifestyle Survey 2012 Main Report
Young People Health and Lifestyle Survey 2008-09 Main Report
Young People Health and Lifestyle Survey 2002 Main Report

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